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A Comparative Study on Ultrasound-Guided Supraclavicular Brachial Plexus Block

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Background: The brachial plexus block can be performed by the landmark nerve technique, nerve stimulator guided (NS) or (ultrasound (US)-guided technique. A patient need not be subjected to the discomfort of paresthesia when the nerve is stimulated to produce a motor twitch, because motor fibers have a lower electrical threshold than sensory fibers. The use of the NS technique, however, did not reduce the complication rates. Therefore, the combined nerve stimulator and ultrasound-guided approach are much preferred. For supraclavicular brachial plexus block. Aim of the Study: Targeting the individual nerve bundles using a nerve stimulator would obtain a higher success rate for ultrasound-guided supraclavicular brachial plexus block. Materials and Methods: 66 patients presenting for upper limb surgeries under USG guided Supraclavicular brachial plexus block were randomly assigned into 2 Groups. Group USG NS– Ultrasound-guided, nerve stimulated Supraclavicular block group USG – Ultrasound-guided Supraclavicular block patients received a mixture of 23 ml of a local anesthetic containing 2% Lignocaine 11.5 ml and 0.75% Ropivacaine 11.5 ml. Group USG NS– (n = 33) – half the volume of drug is injected into ‘corner pocket’ guided by USG, confirmed by nerve stimulation and remaining half the volume is injected into main neural cluster under USG guidance, confirmed by nerve stimulation. Group USG – Under USG guidance half the volume was deposited in ‘corner pocket’ and half the volume was injected in the main neural cluster. Sensory and motor blockade of ulnar nerve, median nerve, musculocutaneous nerve, and radial nerve was recorded at different time intervals. Surgical anesthesia, number of needles passes, performance time and complications were also recorded. Results: Compared with Group USG, Group USG NS had higher success rate of combined sensory-motor block within 15 min (79% vs 52%, p < 0.001). The success rate of sensory block of 4 nerves within 15 min is higher in Group USG NS (Ulnar nerve-91 vs 70%, Median nerve – 91 vs 73%, radial nerve-88 vs 67%, Musculocutaneous nerve 88 vs 64%, p < 0.001). The performance time is increased by 4 min in USG NS Group (14.3 ± 2.88 vs 10.33 ± 5.69 min, p < 0.001). Conclusion: USG guided nerve stimulated supraclavicular brachial plexus block provides higher success rate and complete sensory-motor blockade of all four nerves within 15 minutes of local anesthetic injection.

Perspectives

Background: The brachial plexus block can be performed by the landmark nerve technique, nerve stimulator guided (NS) or (ultrasound (US)-guided technique. A patient need not be subjected to the discomfort of paresthesia when the nerve is stimulated to produce a motor twitch, because motor fibers have a lower electrical threshold than sensory fibers. The use of the NS technique, however, did not reduce the complication rates. Therefore, the combined nerve stimulator and ultrasound-guided approach are much preferred. For supraclavicular brachial plexus block. Aim of the Study: Targeting the individual nerve bundles using a nerve stimulator would obtain a higher success rate for ultrasound-guided supraclavicular brachial plexus block. Materials and Methods: 66 patients presenting for upper limb surgeries under USG guided Supraclavicular brachial plexus block were randomly assigned into 2 Groups. Group USG NS– Ultrasound-guided, nerve stimulated Supraclavicular block group USG – Ultrasound-guided Supraclavicular block patients received a mixture of 23 ml of a local anesthetic containing 2% Lignocaine 11.5 ml and 0.75% Ropivacaine 11.5 ml. Group USG NS– (n = 33) – half the volume of drug is injected into ‘corner pocket’ guided by USG, confirmed by nerve stimulation and remaining half the volume is injected into main neural cluster under USG guidance, confirmed by nerve stimulation. Group USG – Under USG guidance half the volume was deposited in ‘corner pocket’ and half the volume was injected in the main neural cluster. Sensory and motor blockade of ulnar nerve, median nerve, musculocutaneous nerve, and radial nerve was recorded at different time intervals. Surgical anesthesia, number of needles passes, performance time and complications were also recorded. Results: Compared with Group USG, Group USG NS had higher success rate of combined sensory-motor block within 15 min (79% vs 52%, p < 0.001). The success rate of sensory block of 4 nerves within 15 min is higher in Group USG NS (Ulnar nerve-91 vs 70%, Median nerve – 91 vs 73%, radial nerve-88 vs 67%, Musculocutaneous nerve 88 vs 64%, p < 0.001). The performance time is increased by 4 min in USG NS Group (14.3 ± 2.88 vs 10.33 ± 5.69 min, p < 0.001). Conclusion: USG guided nerve stimulated supraclavicular brachial plexus block provides higher success rate and complete sensory-motor blockade of all four nerves within 15 minutes of local anesthetic injection.

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This page is a summary of: A Comparative Study on Ultrasound- Guided Supraclavicular Brachial Plexus Block Vs Ultrasound Guided Nerve Stimulated Supraclavicular Brachial Plexus Block, Indian Journal of Anaesthesia and Analgesia, January 2020, Red Flower Publication Private, Ltd.,
DOI: 10.21088/ijaa.2349.8471.7120.54.
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